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Tuesday, December 10, 2013

Psychological disorders ( including depression and PTSD) and social withdrawal in laryngectomees

The loss of voice and a decrease in physical functioning due to breathing through a stoma are known to result in long-term changes in daily and professional life. There is growing evidence that head and neck cancer patients including laryngectomees are more often anxious and distressed than other cancer patients. Prevalence rates of psychiatric problems in laryngeal cancer patients vary from 20% to 60 %, if nicotine dependence is taken included. Studies reported depression in 4-20% of head and neck cancer patients, anxiety disorder and phobia in 2 - 6%,  adjustment disorder in 4 - 13%, post traumatic stress disorder (PTSD) in 1 -2% and alcohol dependence in 5-33%.

Several recent studies from the University of Leipzig in Germany explored the role of psychological problems in laryngectomees.

Psychological disorders were diagnosed in about a quarter of patients during the first year after laryngectomee according to a new study by Keszte et al. These were evenly distributed among males and females. However, women suffered more often from PTSD and generalized anxiety disorder. Alcohol dependency developed in 80% of the patients who had acquired no voice 80% following laryngectomy. Only 7% of individuals with any mental disorder received psychotherapy one year after laryngectomy. None of the patients diagnosed with alcohol dependency received psychotherapy or psychiatric treatment.

Another study by Danker et al. found that more than 40% of larngectomees withdrew from conversation. Only one-third of all laryngectomees regularly took part in social activities. About 87% perceived stigmatization because of their changed voice and more than 50% felt embarrassed because of their tracheostoma. Almost one-third of the patients had increased anxiety and depression.

These studies illustrates that only one in twelve patients who suffered from psychological disorders following laryngectomy receive adequate psychotherapeutic support. Because mental health seems to be related to successful voice restoration, more effort is needed to promote speech rehabilitation after laryngectomy.  Also more programs are needed to combat alcohol dependency. The studies also highlights the urgent need for psychological and social support programs for laryngeal cancer patients.